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FOR OFFICE USE: APPLICATION 'FOR :SANITATION PERMIT -- -------------- ------------------------------------------ Permit No: .7 -_---e 77 ( (Complete in Triplicate) -------------------------------------------- ----------- , Date Issued ----- _``t�7 3 I This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION..- "- - 1� �� = ------�" -: . .CENSUS TRACT ------------------------ Owner's Name/ Phone ` y ' 6f Address _.__ ---. y _ . -License #of., -- Phone f6, Contractor's Name _ //��//ii � ------------°------ Installation will serve: Residence ["'Apartment House,❑ Commercial :❑Trailet Court l❑ Motel ❑Other -------------------------------------------- i Number of living units:__/------ Number of bedrooms _.?-------Garbage Grinder Lot Size A017 ----;4��--------_--- Water Supply: Public System and name-- f' �Q 'G� �� r ��------------------------------------Private E]Character of soil to a depth of 3 feet: Sand'❑ Silt E:1 Clay ❑ Peat El Sandy Loam ❑ Clay Loam �' � Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type ---------------------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f/ PACKAGE TREATMENT ( ] SEPTIC TANK Size-_ "�--res- Liquid Depth - �y-_"" --- - ----------- Capacity � Type � - Material" � �� No. Compartments r�'--- � I r1� Distance to nearest: Wel ------------------------------------Foundation -"--------- Prop. Line _ham-_"_ ------ LEACHING LINE No. of Lines __ - Length of each line__�i " �- ----- Total Length ----------•- 'D' Box. - P✓�- Type Filter MaterialDepth Filter Material Distant to nearest: Well ---------- Foundation ._ _-- .__-- ------- Property Line __ _____________________ SEEPAGE PIT [ Depth ""--- Diameter JV___ Number ----?i------------------- Rock Filled Yes,K No.I❑ T �d �C � `f Water Table Depth ______ _ -- Rock Size'- W ` s r. Distance to nearest: Well -----------:----------------------------Foundation *r--"-""" Prop. Line REPAIR/ADDITION(Prev. Sanitation-Permit-F# .--- ""==- -=-- `v -_ Date -.__:-------:--------------------- Septic ---=------------- -Septic Tank (Specify Requirements) ---- ----------------------- ----------------------------- ----------------- ---- --------------- ----------------------------- Disposal Field (Specify Requirements) ------------ - -------------------------- ---------------------------- I --------------------------- --------- ------------------------------------- ----` ------------------------- `. ------------------- =- ----------'---`--'----- ----------- ------------- -- -- (Draw existing and required addition on reverse si e) �'Chereby certify that I have pr pared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State Laws; and 'Rules and Regulations of the San Joaquin local Health District.-Nome owner or licen- sed agents signature certifies the following: Y "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." , r F Signed ---------------------�O wner _ ------------------- of er than owner 1 ) � DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __- ------------------------------ DATE ------ /`�f--� ----- ------------- BUILDING PERMIT ISSUED ------ ------�- ` DATE ADDITIONAL COMM TS y -- ------------------------------------ -------------------------- -------- -------------- -- --- - - ----------------------- --- - - -- -- ---- ---- ------------------ = ---- ------------------ ---- --- -- - ------------------------ --------- Final Inspection by; -- Date JOAQUIN LOCAL';HEALTH DISTRICT � ,. E. H. 9 1-'68 Rev. M